RESUMO
Thrombotic thrombocytopenic purpura (TTP) consists of the pentad of thrombocytopenia, hemolytic anemia, fever, neurologic abnormalities, and renal disease. We present a case report of acute TTP following a bout of ischemic colitis. This report reminds the clinician that ischemic colitis can be an atypical presentation of TTP. The prompt recognition and treatment of this disease process resulted in a good prognosis for our patient.
RESUMO
Laparoscopic cholecystectomy is now the gold standard for the treatment of symptomatic cholelithiasis. Portal venous thrombosis after laparoscopic cholecystectomy is rare. We report a case of thrombosis of the portal venous system after laparoscopic cholecystectomy in a patient with a latent prothrombin gene mutation. An abdominal computed tomography and magnetic resonance angiogram of the abdomen revealed portal, superior mesenteric, and splenic vein thrombosis. Testing for coagulation disorders showed a heterozygous form of factor II (prothrombin) G20210A mutation. Because of its rarity, information regarding this complication is limited.
Assuntos
Colecistectomia Laparoscópica , Veia Porta , Protrombina/genética , Veia Esplênica , Trombose Venosa/genética , Feminino , Humanos , Angiografia por Ressonância Magnética , Pessoa de Meia-Idade , MutaçãoAssuntos
Anti-Infecciosos Locais/toxicidade , Colite/induzido quimicamente , Constipação Intestinal/tratamento farmacológico , Ácido Dioctil Sulfossuccínico/toxicidade , Enema/efeitos adversos , Hemorragia Gastrointestinal/induzido quimicamente , Peróxido de Hidrogênio/toxicidade , Fosfatos/toxicidade , Tensoativos/toxicidade , Anti-Infecciosos Locais/administração & dosagem , Biópsia , Colite/diagnóstico , Colite/patologia , Colonoscopia , Ácido Dioctil Sulfossuccínico/administração & dosagem , Hemorragia Gastrointestinal/diagnóstico , Humanos , Peróxido de Hidrogênio/administração & dosagem , Mucosa Intestinal/efeitos dos fármacos , Mucosa Intestinal/patologia , Masculino , Pessoa de Meia-Idade , Fosfatos/administração & dosagem , Espécies Reativas de Oxigênio/metabolismo , Tensoativos/administração & dosagem , Úlcera/induzido quimicamente , Úlcera/diagnóstico , Úlcera/patologiaAssuntos
Traumatismos Abdominais/complicações , Doenças do Ducto Colédoco/terapia , Fígado/lesões , Esfinterotomia Endoscópica , Adulto , Colangiopancreatografia Retrógrada Endoscópica , Doenças do Ducto Colédoco/etiologia , Constrição Patológica , Endoscopia do Sistema Digestório , Humanos , Masculino , Stents , Ferimentos não Penetrantes/complicaçõesRESUMO
Mild hypokalemia is common and encountered in a multitude of diseases, but severe hypokalemia leading to rhabdomyolysis is relatively rare. The watery diarrhea, hypokalemia, achlorhydria (WDHA) syndrome caused by vasoactive intestinal polypeptide (VIP)-producing tumors, is an extremely rare cause of hypokalemic rhabdomyolysis and the literature is limited to one case report. We report a second case of an adult who presented with rhabdomyolysis due to severe hypokalemia. Further evaluation revealed that he had a VIP-producing pancreatic neuroendocrine tumor (NET), which was the cause of his hypokalemic rhabdomyolysis. Although rare in occurrence, a high index of suspicion is of paramount importance for establishing the correct diagnosis and treatment.
Assuntos
Hipopotassemia/complicações , Neoplasias Pancreáticas/diagnóstico , Rabdomiólise/etiologia , Vipoma/diagnóstico , Acloridria/etiologia , Adulto , Diarreia/etiologia , Humanos , Hipopotassemia/etiologia , Masculino , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/patologia , Síndrome , Peptídeo Intestinal Vasoativo/sangue , Vipoma/complicações , Vipoma/patologiaRESUMO
Histoplasmosis is endemic to the midwestern and east central states in the United States near the Mississippi and the Ohio River valleys. Ninety-nine percent of patients exposed to histoplasmosis develop only subclinical infection. Liver involvement as a part of disseminated histoplasmosis is well known; however, isolated hepatic histoplasmosis without any other stigmata of dissemination is extremely rare and the literature is limited to only two case reports. We present a rare case of isolated granulomatous hepatitis due to histoplasmosis in a 35-year-old female with dermatomyositis receiving low-dose prednisone and methotrexate. There was no evidence of fungal dissemination elsewhere. High clinical suspicion is critical for early diagnosis and treatment.
Assuntos
Hepatite/diagnóstico , Histoplasmose/diagnóstico , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Feminino , Granuloma/diagnóstico , Granuloma/patologia , Hepatite/etiologia , Hepatite/patologia , Histoplasmose/tratamento farmacológico , Histoplasmose/patologia , Humanos , Fígado/patologiaRESUMO
BACKGROUND: Clostridium difficile-associated diarrhea (CDAD) is a common cause of mortality and morbidity in hospitalized patients. Some case reports have implicated renal failure as a risk factor for CDAD. The aim of this study was to assess whether chronic renal insufficiency is a risk factor for CDAD and whether it increases mortality and morbidity. METHOD: We reviewed charts of 385 patients with diarrhea for CDAD, chronic renal insufficiency, mortality, and recurrence of CDAD. RESULTS: Seventy-seven patients had infection due to C difficile. There was no difference in the chronic renal insufficiency, mortality, and other comorbid conditions between patients who had C difficile infection and those who did not. The patients with CDAD and chronic renal insufficiency had significantly higher mortality and recurrence of CDAD than patients without chronic renal insufficiency. CONCLUSIONS: Chronic renal insufficiency is not a risk factor for CDAD, but its presence with CDAD increases mortality and recurrence of CDAD.
